Provider Demographics
NPI:1962579029
Name:TEMPLE UNIVERSITY HOSPITAL, INC
Entity type:Organization
Organization Name:TEMPLE UNIVERSITY HOSPITAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN DIRECTOR, PATIENT ACCOUNTING
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:KOCOTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-707-5303
Mailing Address - Street 1:3401 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-5103
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3401 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5103
Practice Address - Country:US
Practice Address - Phone:215-707-5303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA200701282N00000X
282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
390027OtherUNITED HEALTHCARE
390027OtherPRIVATE HEALTHCARE
PA1007351140008Medicaid
390027OtherCIGNA
390027OtherDEVON
390027OtherCHAMPUS TRICARE
NJ60027OtherHORIZON NJ
PA60027OtherKEYSTONE MERCY
11OtherELDERHEALTH
390027OtherGEISINGER
PA60007OtherKEYSTONE MERCY EPISCOPAL
PA00018OtherHEALTH PARTNERS
PA0158198701OtherAMERICHOICE
390027OtherHEALTH AMERICA
1401OtherAETNA
PA4570OtherIBC KHPE
PA4570OtherIBC KHPE